Table 3. Framework for integrating MET into clinical practice for tobacco cessation in schizophrenia.

NRT: nicotine replacement therapy; MET: motivational enhancement therapy

Step/phase	Description	Implementation strategies	Expected outcomes
Initial assessment and engagement [46]	Evaluate tobacco use, motivation level, and readiness for change in patients with schizophrenia	Use standardized tools such as the Fagerström test for nicotine dependence and motivational interviewing techniques	Build rapport and gain insight into the patient's tobacco use patterns and motivation level
Setting personalized goals [47]	Collaborate with the patient to set achievable and personalized tobacco cessation goals	Tailor goals are based on the patient’s readiness to quit, cognitive capacity, and individual preferences	Increased patient engagement and commitment to the quitting process
Tailoring MET Sessions [48]	Adapt MET sessions to address schizophrenia-specific challenges such as cognitive impairments and comorbidities	Use simplified language, visual aids, and repetition. Focus on schizophrenia-related smoking triggers	Enhanced understanding and retention of MET strategies, fostering behavior change
Integration with pharmacotherapy [49]	Combine MET with NRT or other cessation medications like bupropion or varenicline	Regularly assess the effectiveness of the pharmacotherapy and make adjustments as needed	Improved smoking cessation outcomes through combined behavioral and pharmacological approaches
Monitoring and relapse prevention [50]	Continuous monitoring of progress and addressing potential relapses	Schedule regular follow-up visits, use telehealth when necessary, and maintain MET reinforcement sessions	Reduced relapse rates and sustained abstinence from smoking
Multidisciplinary collaboration [51]	Work closely with psychiatrists, psychologists, and other mental health professionals	Ensure communication between healthcare providers for coordinated care	Holistic patient care ensures both mental health and tobacco cessation needs are addressed
Addressing comorbid substance use [52]	Identify and manage co-occurring substance use disorders in patients with schizophrenia	Integrate MET strategies with broader substance use treatment plans	Improved overall addiction management and support for quitting tobacco
Family and social support involvement [53]	Engage family members or caregivers in the MET process to support the patient’s cessation efforts	Provide education to families about schizophrenia and tobacco dependence and involve them in MET sessions when appropriate.	Increased social support and accountability, fostering greater success in cessation.